Background: Spreading data describe cardiovascular disease (CVD) as a growing cause of hospitalization in systemic sclerosis (SSc) patients. Although interstitial lung disease and pulmonary arterial hypertension (PAH) remain the principal causes of mortality, the presence of CVD has been shown to further increase mortality in SSc patients. Few and contrasting data are available on cardiovascular impairment, particularly of subclinical coronary arteries disease, in SSc patients. The aims of this study were: 1) to determine the demographic, clinical, and cardiovascular differences between the groups of SSc patients with and without subclinical coronary atherosclerosis (SCA) assessed by coronary calcium score; 2) to verify the performance of cardiovascular risk scores in SSc for detection of SCA major cardiovascular events (MCVE); 3) to evaluate the risk factors associated to MCVE in 5 years of follow-up in this study group of patients.Methods: Sixty-seven SSc patients were enrolled in this study. SCA was assessed using quantification of coronary calcium score by computerized tomography, reported as Agatson. Evaluation of common cardiovascular risk scores, carotid plaques by Doppler ultrasonography, the history of peripheral artery disease (PAD), lipid profiles, and clinical and laboratiristic characteristics of SSc were assessed at baseline visits for each patient. Factors associated with the presence of SCA were assessed by multivariate logistic analysis. A five years prospective study was performed for the evaluation of MCVE occurrence and its possible predictors.Results: The prevalence of SCA was 42% (Agatston scores of 266.04 & PLUSMN; 455.9 units) in our group of SSc patients. Patients with SCA were principally older (p = 0.0001) and had higher rates of CENP-B antibodies (57% vs 26%; p = 0.009), pulmonary arterial hypertension (PAH) (25% vs 3%; p = 0.008), dysphagia (86% vs 61%; p = 0.027), and users of statins (36% vs 8%; p = 0.004), carotid plaque (82% vs 13%; p = 0.0001), PAD (79% vs 18%; p = 0.0001), and metabolic syndrome (25% vs 0%; p = 0.002) than patients without SCA. Metabolic syndrome (OR: 8.2, p = 0.0001), presence of a PAD (OR: 5.98, p = 0.031), and carotid plaque (OR: 5.49, p = 0.010) were the main factors associated with SCA in SSc patients, by multivariate regression analysis. MCVE occurred in 7 patients. By multivariate COX regression analysis unique predictor of MCVE in 5 years of follow-up in our SSc patients was the presence of PAH (HR: 10.33, p = 0.009). Of note, the contemporary presence of PAH and SCA (defined as "not pure" pattern of PAH) was observed in 71% of patients with the occurrence of MCVEConclusion: This study evidenced the high presence of the new "not pure" pattern of PAH, which could worsen the outcome in SSc in a medium-term (5 years) observation period. Furthermore, our data confirmed a higher cardiovascular impairment in SSc due to the presence of both SCA, mainly associated with typical cardiovascular risk factors, and PAH, life-threatening complications of SSc, that is the principal cause of the occurrence of MCVE in our SSc patients. A careful assessment of cardiovascular involvement in SSc and a more aggressive therapeutic strategy for preventing CAD and treating PAH should be highly suggested to reduce MCVE in SSc patients.

Ozone therapy is a minimally invasive technique now widely used for the treatment of pain due to herniated discs. In literature there are conflicting results concerning its real effectiveness and few data about its possible complications. In this case report we present a case of spondylodiscitis, septic arthritis and gluteal abscess following the execution of 4 sessions of ozone therapy. Given the impossibility of isolating the etiological agent, an empirical antibiotic therapy with an overall duration of 6 weeks was set up, initially with daptomycin and ceftriazone, to which was added after 2 days metronidazole, administered intravenously; after 20 days the cephalosporin was replaced with oral amoxicillin/clavulanate. Neridronate was added to treat bone edema and to avoid bone erosion. The patient showed improvement of both clinical conditions and inflammation indexes, and was discharged after 4 weeks without further complications at follow-up. Few cases are reported in the literature about spondylodiscitis secondary to ozone treatment, and just 1 case is described about the use of neridronate as additive drug to antibiotic treatment in spondylodiscitis to avoid bone disruption and surgery complications.

Background Rheumatoid Arthritis (RA) represents a huge burden for patients’ quality of life and there are still relevant unmet needs in its management due to uncovered patients’ needs even once sustained remission is achieved. Objectives This study aimed to investigate disease burden, treatment priorities and preferences across disease phases comparing patients’ and physicians’ perspectives. Methods Consultants or residents in rheumatology (across Academic and non-academic hospitals) and patients with RA both aged ≤40 years were reached by an anonymous online survey between November 2021 and November 2022, designed by the SIRyoung commission. For each included RA patient, demographic and clinical parameters (RA diagnosis timing, current and previous treatments) were collected. For each included physician demographic, education and professional profile details were collected. Results Two-hundred seventy-four consultants or residents in rheumatology and 90 RA patients, both aged ≤40 years, completed the online survey. All Italian regions were equally represented for both physicians’ and patients’ subgroups. Considering the patients’ disease referral status, 26(28.9%) received RA diagnosis at the very early stage (≤3 months), 33(36.7%) at early stage (3-12 months) and 31(34.4%) after 12 months from symptoms’ onset. When asked for the priority in RA treatment objectives, the survey revealed a different priority among the subgroups with a higher importance given to fatigue resolution (p<0.0001) and morning stiffness reduction (p<0.0001) by patients and to radiological damage prevention (p=0.01) and disability reduction (p=0.0108) by physicians, while comparable priority was given by the 2 groups to pain relief, physical function restoration and work-ability recover (p>0.05 for all). When asked about the factors that could improve RA management, the survey revealed higher agreement scores for patients compared to physicians in educational need (p<0.0001), increase of outpatient visits and access to treatment (both p<0.0001) and use of digital apps (p<0.0001). Stratifying patients based on self-perceived disease control, 30(33.3%) were well controlled, 52(57.8%) moderately controlled and 8(8.9%) very poorly controlled. When questioned about their will to treatment modification once sustained remission status is achieved, patients showed a higher agreement of maintaining the treatment unchanged (p=0.0002) and a higher fear of modification consequences (p<0.0001) compared to physicians, mostly if not guided by the treating rheumatologist or out of established decisional algorithms. Conclusion Young patients with RA and young rheumatologists have variable agreements on treatment aims and priority. In particular, when dealing with the sustained remission status, a shared decisional algorithm between physicians and patients is needed to reduce patients fear and improve their empowerment. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests None Declared.

A growing body of evidence on the importance of vitamin D in immune modulation has increased the interest in its possible impact on the course of rheumatological diseases. The scope of our study is to assess if the presence of different statuses of vitamin D could interfere in the clinical subsets, in methotrexate monotherapy discontinuation, and biological drug (b-DMARDs) survival in psoriatic arthritis patients (PsA). We conducted a retrospective study on PsA patients and split them into three groups based on their vitamin D status: the group with 25(OH)D ≤ 20 ng/mL, the group with levels of 25(OH)D between 20 and 30 ng/mL, and the group with serum levels of 25(OH)D ≥ 30 ng/mL. All patients were required to fulfill the CASPAR criteria for psoriatic arthritis and to have the evaluation of vitamin D serum levels at baseline visit and at clinical follow-up visits. The exclusion criteria were ages less than 18 years old, the presence of HLA B27, and satisfaction of rheumatoid arthritis classification criteria (during the study time). Statistical significance was set at p ≤ 0.05. Furthermore, 570 patients with PsA were screened and 233 were recruited. A level of 25(OH)D ≤ 20 ng/mL was present in 39% of patients; levels of 25(OH)D between 20 and 30 ng/mL presented in 25% of patients; 65% of patients with sacroiliitis presented 25 (OH)D ≤ 20 ng/mL. Methotrexate monotherapy discontinuation for failure was higher in the group with 25 (OH)D ≤ 20 ng/mL (survival time: 92 ± 10.3 weeks vs. 141.9 ± 24.1 weeks vs. 160.1 ± 23.6 weeks; p = 0.02) with higher discontinuation risk (HR = 2.168, 95% CI 1.334, 3.522; p = 0.002) than those with 25(OH)D between 20 and 30 ng/mL and those with 25(OH)D ≥ 30 ng/mL. Significantly shorter survival of first b-DMARDs was assessed in the group with 25 (OH)D ≤ 20 ng/mL versus the other groups (133.6 ± 11 weeks vs. 204.8 ± 35.8 weeks vs. 298.9 ± 35.4; p = 0.028) (discontinuation risk 2.129, 95% CI 1.186, 3.821; p = 0.011). This study highlights significant differences in clinical presentation, in particular sacroiliac involvement and on drug survival (methotrexate and b-DMARDs) in PsA patients with vitamin D deficiency. Further prospective studies, including a larger sample of patients, are needed to validate these data and to assess if the supplementation of vitamin D could improve the b-DMARDs response in PsA patients.

BackgroundThe primary prevention of cardiovascular disease (CVD) is a priority element of the worldwide health care agenda. An increased risk of CVD and CV mortality has been shown in lots of studies conducted on patients affected by inflammatory and autoimmune diseases. A routine evaluation of CV risk in these patients should be encouraged and in particular cases is recommended.ObjectivesThe aim of this study is to evaluate the presence of subclinical atheromatosis, the CV risk and its performance in a cohort of patients affected by Systemic Sclerosis (SSc) from a single reference tertiary care hospital.MethodsSixty-seven patients with SSc according to the ACR/EULAR 2013 criteria were included. Traditional CV risk factors and SSc related factors were analyzed. Thoracic high resolution computed tomography (CT) was performed, using the quantification of coronary calcium for the study. Furthermore, a doppler ultrasonography of the carotids and the lower extremity arteries was conducted for the detection of subclinical atheromatosis. The CV risk has been calculated through different CV risk scales including the MESA CAC, the Italian Progetto Cuore, the Framingham score, the Score2 and the QRISK3. After conducting a 5-year follow up, CV outcome and electrocardiography abnormalities were examined.ResultsCalcium artery coronary score > 0 was reported in twenty-eight SSc patients (41,8%). Considering traditional CV risk factors, the multivariate regression analysis showed a correlation with age (OR 1.151 [95% CI 1.06–1.25], P = 0.001) and systemic arterial hypertension (OR 5 [95% CI 1.148–22.357], P = 0.032). Instead, the presence of anti-CENP-B (OR 3.47 [95% CI 1.09–11.06], P = 0.035) and late-onset disease (OR 1.062 [95% CI 1.007–1.119], P = 0.026) were identified as potential specific disease risk factors. The prevalence of ultrasonography atherosclerosis was high: peripheral artery disease (PAD) and carotid plaque were respectively 43% and 41%, and the presence of coronary calcifications was a risk factor for their detection with a OR respectively of 20.39 and 20.49 (p=0.0001). All CV risk scores considered SSc patients in a low risk, except for the QRISK3, whose values were higher in patients with coronary calcifications (18.4±12.6 vs 5.1±4.9, p=0.0001). In 5-years follow up only 1 patient died for CVD and 2 CV events occurred. Electrocardiography anomalies were found in 28.35% of patients, and in particular in 43% of patients with coronary calcifications (OR 3.321 [95% CI 1.094-10.08], P = 0.03).ConclusionSubclinical coronary atherosclerosis seems to be largely observed in SSc patients and may represent an additional risk factor for electrocardiography anomalies and subclinical atheromatosis in other anatomical districts, with no impact on CVD mortality. In our study coronary calcifications well correlated with CV risk score, especially the novel QRISK3 by classifying these patients between low and moderate CV risk. Other studies are needed to support the hypothesis that subclinical coronary atherosclerosis, occasionally detected in thoracic CT, may represent a clinical alert to establish timing and weight of diagnostic and specific treatment protocols for the CV prevention in SSc patients.References[1]Agca R, Heslinga SC, Rollefstad S, et al. EULAR recommendations for cardiovasculardisease risk management in patients with rheumatoidarthritis and otherforms of inflammatory joint disorders: 2015/2016 update. Ann RheumDis 2017; 76(1):17–28.[2]Ungprasert P, Charoenpong P. Risk of coronary artery disease in patients with systemic sclerosis: a systematic review and meta-analysis. ClinRheumatol. 2014;33(8):1099-1104[3]Sanz Pérez I, Martínez Valle F. Subclinical cardiovascular disease and Systemic Sclerosis: A comparison between risk charts, quantification of coronary calcium and carotid ultrasonography. Autoimmun Rev. 2018;17(9):900-905[4]Di Battista M, Barsotti S, Della Rossa A, Mosca M. Cardiovascular burden in systemic sclerosis: QRISK3 versus Framingham for risk estimation. ModRheumatol. 2021; roab011.Disclosure of InterestsNone declared

Purpose This study aims to investigate nailfold capillary (NF) changes in patients with Systemic Lupus Erythematous (SLE), and its association with disease activities, autoantibodies, clinical symptoms. Methods 52 patients were enrolled (7 m and 45 f), between 2015 and 2022, and underwent to NF. Alterations in capillary morphology, diameter, architecture and density were analyzed. CSURI index was calculated. Clinical symptoms and autoantibodies were reported. Disease activity was evaluated by SLE disease index (SLEDAI). Results 46% of the enrolled patients showed non-specific pattern, 6% early scleroderma pattern (EAP), 18% like-scleroderma pattern (LSP), 26% normal pattern. The most frequent microvascular alterations were tortuous capillary (81%), edema (54%), enlarged capillaries (30%), capillary hemorrhage (26%), prominent subpapillary plexus (7%), giant capillaries (6%), elongated capillaries (6%) and bushy capillaries (6%). Considering disease activity, the patients in clinical remission highlighted in 60% of cases a normal NF pattern, in 40% non-specific pattern. The patients with moderate disease activity showed in 7% of cases EAP, and in 10% LSP. The patients with high disease activity evidenced in 6% of cases EAP, 41% LSP. The capillary abnormalities rates noticed in subgroups of patients relating disease activity, respectively low, moderate and high activity, were edema (20% vs 57% vs 65%), tortuous capillary (80% vs 80%, 94%), bushy capillaries (0% vs 4% vs 2%), elongated capillaries (0% vs 7% vs 6%), prominent subpapillary plexus (0% vs 2% vs 6%), capillary hemorrhage (40% vs 30% vs 18%), enlarged capillaries (0% vs 23% vs 53%; p=0,031), giant capillaries (0% vs 7% vs 6%). Subdividing the LES patients on the basis of Raynaud's Phenomenon (RF) presence, those with RF, compared to patients without RF showed higher frequency of ESP (12,5% vs 0%) and LSP (25% vs 14%). The most frequent capillary alterations evidenced in patients with RF compared with patients without RF were edema (58% vs 53%), tortuous capillary (95% vs 75%), enlarged capillaries (42% vs 21%), giant capillaries (12% vs 0%), disorganization of capillary array (4% vs 0%), bushy capillaries (8% vs 3%) and prominent subpapillary plexus (8% vs 7%). The patients without RF, compared to patients with RF presented more often a normal pattern (36% vs 17%) and non-specific pattern (56% vs 44%). The most frequent capillary abnormalities highlighted in patients without RF were elongated capillaries (7% vs 4%) and capillary hemorrhage (28% vs 25%). The patient with glomerulonephritis did not show significant differences compared to patients without glomerulonephritis. Conclusions several capillary alterations were founded in SLE patients. The association between disease activity and capillary changes was highlighted. In particular, moderate and high disease activities were often correlated to altered capillary pattern such as like and EAP, and to capillary abnormalities such as enlarged capillaries. Also, patients with RF showed a higher association with capillary alterations than patients without RF.

Previous research has shown conflicting reports about the effect of systemic sclerosis (SSc) on bone metabolism, especially considering bone mineral density (BMD), bone microarchitecture, and risk of fracture. The objective of this review is to analyze data from previous articles to investigate the differences in BMD and fracture risk between SSc and non-SSc populations and to discuss potential underlying mechanisms. The main factors investigated have been BMD (mean and standard deviation), t-scores and z-scores at the lumbar spine, femoral neck, and total hip measured by dual-energy X-ray absorptiometry (DEXA), bone remodeling markers, fracture prevalence, and incidence, trabecular bone score (TBS), musculoskeletal involvement with particular correlation to SSc skin subtype and extent, disease duration, serological pattern, and vitamin D levels. Since microvascular alterations evaluated through nailfold videocapillaroscopy (NVC) of SSc patients have recently been correlated with decreased BMD and bone microarchitecture, the vascular impairment in SSc has been proposed as a remarkable contributing element in bone remodeling, and the role of hypoxia has been investigated.

Background Limited data on myoglobin and infectious diseases are available. In this study, we evaluate the potential role of myoglobin in predicting poor outcome in patients with Sars-Cov2 pneumonia. Methods One hundred and twenty-one Sars-Cov 2 patients with an average age of 69.9 +/- 13.2 years, and symptoms duration of 8.8 +/- 7.9 days were enrolled in the study. At the admission, the serum levels of myoglobin, erythrocyte sedimentation rate, C reactive protein (CRP), procalcitonin, ferritin, creatine phosphokinase, creatinine, fibrinogen, d-dimers, lactic dehydrogenase, troponin (Tn-I), creatine kinase myocardial band (CK-MB), complement fractions C3 and C4, immunoglobulins, interleukin 6 were evaluated. We also assessed the patients' complete clinical history and performed a thorough physical examination including age, disease history, and medications. Results Twenty-four (20%) patients died, and 18 (15%) patients required intensive care. The mean time between symptoms onset and death was 12.4 days +/- 9.1. Univariate analysis of the patients' data highlighted some independent risk factors for mortality in COVID-19, including higher neutrophils rate (HR: 1.171), lower lymphocyte rate (HR: 0.798), high CK-MB serum levels (HR: 1.6), high Tn-I serum levels (HR: 1.03), high myoglobin serum levels (HR: 1.014), Alzheimer (HR 5.8), and higher CRP values (HR: 1.011). Cox regression analysis model revealed that higher serum values of myoglobin (HR 1.003; 95%CI: 1.001-1.006; p = 0.01), and CRP (HR 1.012; 95% CI: 1.001-1.023; p = 0.035) could be predictors of mortality in COVID-19 patients. The value of the myoglobin level for predicting 28 days-mortality using ROC curve was 121.8 ng/dL. Lower survival rate was observed in patients with serum levels of myoglobin>121.8 ng/dL (84% vs 20% respectively, p = 0.0001). Conclusion Our results suggest that higher serum levels of myoglobin could be a considerable and effective predictor of poor outcomes in COVID-19 patients; a careful follow-up in these patients is strongly suggested. The possibility of enhancing these findings in other cohorts of COVID-19 patients could validate the clinical value of myoglobin as a biomarker for worse prognosis in COVID-19.

An increased risk of developing severe infections has been evidenced in rheumatic disease (RD) patients, and anti-COVID-19 vaccination is strictly recommended for RD patients. However, up to now, no data are available on safety, immunogenicity and efficacy of COVID-19 vaccinations in RD patients. The possible development of adverse events (AEs), including the flare-up of underlying RD, represents a matter of growing importance. The aim of our study is to assess, in RD patients, the safety profile of different types of approved vaccines and the possible influence of immunosuppressive therapies and clinical or demographic characteristics of RD patients on development of AEs. Participants (n = 185; 30.7%) received anti-COVID-19 vaccinations, 137 with autoimmune/chronic inflammatory RD (Au/cIn-RD) and 48 with nonautoimmune/chronic inflammatory RD (no-Au/cIn-RD). AEs were recorded in 42% of patients after the first dose of vaccine, and in 26% of patients after the second dose. The most common reported AEs after anti-COVID 19 vaccines were site injection pain (17%), headache (12%), fever (12%), myalgia (10%) and fatigue (10%). Relapses of the underlying Au/c-In-RD were recorded in 2.2% of patients after the first dose of vaccine. In Au/c-In-RD the risk of developing AEs after the first dose of vaccine was lower in older patients (OR = 0.95; p = 0.001), and in the group of patients with complete control of RD (OR: 0.2; p = 0.010). A lower percentage of AEs was observed in patients with complete control of their Au/cIn-RD (29%) compared to those with low (57%) or moderate-high disease activity (63%) (p = 0.002 and p = 0.006 respectively). In this study all types of COVID-19 vaccines in use in Italy seemed safe in RD patients. The results of this study might provide reassuring information for Au/cIn RD patients and clinicians and could strengthen the data on vaccine safety to guide the use of COVID-19 vaccines in Au/cIn-RD on immunosuppressive agents.

The association between estrogen receptor (ER) positive breast cancer (BC) and autoimmune disorders has been recently recognized. In particular exposure to aromatase inhibitors is associated with a significant increased risk of rheumatological autoimmune disorders. The purpose of this study was to investigate Sjögren syndrome (SjS) occurrence in patients with ER-positive BC. This is a prospective study analyzing 110 consecutive patients with ER-positive BC treated with anti-hormonal therapy. New 2016 American College of Rheumatology/European League against Rheumatism (ACR-EULAR) classification criteria were used to identify patients with SjS. Ultrasonography of salivary glands (SG) was used to screen patients with negative disease biomarkers, to candidate them to SGs biopsy. Sicca syndrome was detected in 51 patients (46%), whereas a true primary SjS was diagnosed in 11 patients (10%). Even if the evaluation of incidence and prevalence of primary SjS vary widely, to the best of our knowledge, the data from the present study emphasize a previously unsuspected high prevalence of defined pSjS that causes BC sicca symptoms complaints. Hypothesis, explanation of this link and even possible biases are discussed.

Background:Cardiovascular disease is the leading cause of morbidity and mortality worldwide. Myocardial calcifications have been related with cardiovascular diseases (CVD) such as focal wall motion abnormalities and arrhythmias. The impact of vascular calcifications is under investigation in order to define the risk of cardiovascular events. The relationship between cardiac calcification and systemic sclerosis (SSc) has not been investigated.Objectives:The aim of the study is to evaluate the frequency of different patterns of cardiac calcification in SSc patients, and to correlate them to other CVD risk factors.Methods:We analyzed thoracic-CT scanners of 35 SSc patients (88% female, aged 47,8 ys ±12,9, disease duration 12,8 ys ±9) to determine the location and extension of vascular and cardiac calcification. All recruited patients fulfilled the 2013 ACR-EULAR classification criteria for SSc. No one patients had renal failure, cardiomyopathy, myocarditis, history of cardiac surgery or radiotherapy.Results:We found myocardial vessels calcifications (MCv) in 37% SSc patients, aortic wall calcifications (ACw)in 60% SSc patients, cardiac valve calcifications (VC) in 28% SSc patient and heart wall calcifications (HCw) in 20%.The SSc patients with almost one calcification had older age (65±9,8 ys vs 50±8,8 ys; p=0,0001) and higher values of circulating NTproBNP (336,9±351,9 vs 144,2±107,8; p=0,04) compared to those without.In particular, the SSc patients with MCv had and uric acid (5,3 ±1,5 vs 4,1 ±1,3; p=0,05), higher rate of PAH (25% vs 0%; p=0,037), arrhythmia (38,5% vs 9%; p=0,036) and higher prevalence of CENP-B antibodies(46% vs 4%; p=0,01) compared to patients without MCv.Patients with HCw had lower C reactive protein (0,16 ±0,10 vs 0,7±0,7; p=0,008) compared to those without HCw. No differences in the rate of heart and vascular complications of SSc were observed.The SSc patients with ACw had higher frequency of arrhythmia (33% vs 0%; p=0,016) and longer disease duration (15,5 y ±9,9 vs 8,8 ±5,8; p=0,03).The SSc patients with VC had higher rate of PAH (33%vs0%; p=0,003) and uric acid (6±0,5vs3,8±1,2 p=0,0001).Regression analysis excluded any association with gender, BMI, systemic arterial hypertension, steroid therapy, hypovitaminosis D or smoke habit. No cardiovascular event was recorded in one year of observation.Conclusion:All patterns of calcifications may be related mostly with the older age. Myocardial vessels calcifications have been found in a high percentage of SSc patients and in particular in those with PAH and positive for anti CENP-B. Furthermore, myocardial vessels calcifications could be associated to the higher occurrence of arrhythmia. More studied are needed to assess the importance of vascular calcification as a part of the vascular involvement in SSc.References:[1]John W. Nance Jr. MD. Myocardial calcifications: Pathophysiology, etiologies, differential diagnoses, and imaging findings. Journal of Cardiovascular Computed Tomography 9 (2015) 58 e 67.[2]Pagkopoulou E, Poutakidou M. Cardiovascular risk in systemic sclerosis: Micro- and Macro-vascular involvement. Indian J Rheumatol 2017;12, Suppl S1:211-7[3]Plastiras SC, Toumanidis ST. Systemic sclerosis: the heart of the matter. Hellenic J Cardiol. 2012;53(4):287–300.Disclosure of Interests:None declared

Background:The third-generation aromatase inhibitors (AIs) have shown a favorable overall risk–benefit profile in the upfront adjuvant therapy of postmenopausal estrogen receptor–positive breast cancer. Breast cancer patients treated with long term AIs experience arthralgias and musculoskeletal aching often described as bone pain, musculoskeletal disorder, arthralgia.Objectives:The purpose of this study was to investigate clinical, serological and anamnestic features associated to the joint pain syndrome in non-metastatic breast cancer patients treated with adjuvant AIs.Methods:Between June 2017 and December 2017 patients with early stage estrogen receptor–positive breast carcinomas treated with adjuvant letrozole, attending our Rheumatologic clinic to undergo osteoporosis screening, were included. Pre-existing symptoms and clinical, serological and imaging features were evaluated to assess the type of musculoskeletal disorder.Results:Among 64 patients included a musculoskeletal syndrome was detected in 46 patients (71.8%), whereas diffuse muscle pain was observed in 42 (65.6%) patients, and 83.3% of them had associated arthritis. Serological, imaging and clinical findings suggested more frequently a seronegative arthritis, whereas few patients developed rheumatoid arthritis and arthritis secondary to a connective tissue disease. A direct correlation between pre-existing autoimmune disease and pain symptoms before cancer diagnosis and risk of developing arthritis under AI therapy was observed. Mean vitamin D levels were significantly lower in patients with diffuse myalgia compared to patients with no diffuse myalgia (11.2±5.8 versus 29.5±10.8 ng/ml; t-test p < 0.0001), suggesting a potential involvement of vitamin D deficiency in diffuse muscle pain.Conclusion:The etiology of AI-associated pain syndrome remain unknown, but clinical, serological, imaging data may be useful to identify the true origin of the musculoskeletal syndrome, as well as a detailed anamnestic history may be useful to identify autoimmune predisposing factors. Myalgias and generalized weakness are likely associated with hypovitaminosis D and might be misdiagnosed as fibromyalgia. The management of these patients should become a multispecialistic task.References[1] Beckwée D, Leysen L. Prevalence of aromatase inhibitor-induced arthralgia in breast cancer: a systematic review and meta-analysis. Support Care Cancer 2017 May;25(5):1673-1686. [2] Borrie AE,Kim RB. Molecular basis of aromatase inhibitor associated arthralgia: known and potential candidate genes and associated biomarkers. Expert Opin Drug Metb Toxicol. 2017 Feb;13(2):149-156.Disclosure of Interests:Stefania Sciacca: None declared, Nadia Melillo: None declared, Francesco Paolo Cantatore Speakers bureau: PFIZER, ROCHE